The objective of this contract is to replicate existing and developed Alaska telemedicine testbeds by modifying, interfacing, and expanding successfully deployed narrow bandwidth telemedicine technologies and applications and to evaluate the impact of these telemedicine technologies and applications on the health care system in rural Alaska for cost, quality of care, and access to care by rural Native Alaskans where and when it is needed. This contract will build upon the organizational successes of the Alaska Telemedicine Project to coordinate the replication of scaled, tested approaches to telemedicine and health care informatics in rural Alaska. This contract will be executed within an environment in which the University of Alaska, and civilian, military, and Native healthcare organizations will develop and promote access to internet-based medical and health care bibliographic databases and electronic publications, practice guidelines, expert systems, as well as a computer-based patient records management system in selected sites in rural Alaska. Confidentiality will be maintained through the use of programs that will allow electronic health care data to be shared among selected rural Alaska villages, their regional health care "hub" and on to tertiary care facilities in Anchorage.